NPR's Marketplace profiles Terlingua (TX) EMS' efforts at improving community health in a rural community. The reporter also highlights the growing challenges for rural EMS agencies in an increasingly challenging economic and staffing environment.

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Rural paramedics are making routine house calls to avoid costly emergency room visits

Travis Bubenik

Jun 28, 2024

https://www.marketplace.org/2024/06/28/community-paramedicine-visits-west-texas-ems-paramedics/

In some rural parts of the U.S., where hospitals and doctors’ offices are in short supply, people often turn to calling 911 just for basic medical care.

Experts say that’s a problem for patients and hospitals, but a growing model called community paramedicine aims to address it by having paramedics regularly check in on people before a health issue turns into an emergency.

One of those programs is playing out in the tiny desert town of Terlingua, Texas, where Susan Martin is chief of the local emergency medical services department. Her small crew, fewer than 10 people, responds to 911 calls across a dusty, 3,000-square-mile range of rural West Texas.

“A lot of what we’re seeing now with the heat is environmental: some dehydration, some heat exhaustion, things like that,” she said.

Martin said they also get calls from people with chronic health issues.

“Some patients don’t understand their medications,” she said. “[As in] ‘They don’t make me feel good so I don’t want to take them, so I don’t take them, then I end up being a 911 call.'”

The closest hospital is more than an hour away, so the local EMS team’s single ambulance can be tied up for a good chunk of the day on an emergency call.

That’s a big part of why Martin’s team has launched a “community paramedicine” program, where paramedics regularly check in on people with known health issues — patients who might not get to the doctor as often as they should.

“A lot of people out here, they’re very like, reclusive,” said Alexandria Hollenbeck, one of the local paramedics. “It tends to be older people, or people with chronic illnesses, such as hypertension, COPD.”

A 2023 survey from a national paramedics trade group counted more than 150 of these kinds of community paramedicine programs across the country. It’s a growing health care model championed by EMS agencies and hospitals at a time when some advocates say rural health care is facing a crisis.

Adrian Billings is a longtime West Texas doctor and rural health expert at Texas Tech University.

“This area is one of the most under-resourced health care areas in our state,” he said.

For patients, Billings said, routine paramedicine check-ins at home can avoid expensive emergency room visits. Hospitals want to avoid that too, as they can face penalties when too many patients come back to the emergency room soon after release. That’s called a readmission.

“From a financial standpoint, community paramedicine programs do help cut down on readmissions that can be very costly for hospitals,” Billings said.

One KFF Health News analysis from 2022 tallied $320 million in hospital readmission penalties nationwide. 

But even though paramedicine programs can save big on costs, preventative care like this requires an upfront investment.

“The economic model for EMS-based community paramedicine is very challenging.” said Matt Zavadsky, a longtime emergency medicine professional in Texas who now works for a national consulting firm for EMS operations. 

He said insurance providers — Medicare, Medicaid and private insurers — mostly don’t cover paramedics making house calls. 

“So we’ve got EMTs and paramedics all over the country who are doing the right thing by trying to work with patients to prevent unnecessary emergency department visits, but yet they’re not eligible for reimbursement,” he said.

The new paramedicine program in small-town Terlingua is being funded as part of a broader $5 million  U.S. Department of Agriculture rural development grant, with no guarantees for long-term funding. 

“Being able to prove to the payers that these programs are economically more efficient than a 911 call to the emergency department is going to be crucial for those rural communities to sustain these outstanding programs,” Zavadsky said.

He hopes that with time and data, community paramedicine programs will be able to prove their worth to health care insurers.

EMS and public safety have done a great job for decades educating people about using 9-1-1 for emergencies. But we haven’t done a great job educating them about what constitutes an ‘emergency’.

We often say that there may be no such thing as an inappropriate 9-1-1 request, but there is such a thing as an inappropriate response to that request.

Communities should evaluate options for matching the right response to each 9-1-1 call. Often, as Kern County is finding, and as any EMS provider can tell you from personal experience, most 9-1-1 EMS calls are NOT for true emergencies.

Effective Emergency Medical Dispatch programs, paired with alternate response options such as dispatch triage, 2-1-1 integrations, community paramedicine responses, and even partnering with Lyft or Uber to provide non-medical transport services for low/no-acuity 9-1-1 calls, can be effective options to preserve scarce EMS response resources.

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Kern residents continue to abuse 911 system, officials say

BY JOHN DONEGAN

Jun 24, 2024

https://www.bakersfield.com/news/kern-residents-continue-to-abuse-911-system-officials-say/article_a209a9a0-3273-11ef-be57-6b95ffa41612.html

Facilities of the 911 emergency system are being drowned in a flood of trivial calls, officials said at a news conference Monday.

Held at Kern County Public Health’s Mt. Vernon Avenue headquarters in Bakersfield, leaders from the 911 system continuum — from firefighters to dispatchers to medical workers — urged the public not to dial 911 unless there is a genuine emergency.

The call to “not call” came as authorities are seeing a steady rise in 911 reports — about a third more since 2019 and a slight bump from the year prior. As of Monday, EMS Program Manager Jeff Fariss with Kern Public Health said the county expects to exceed 13,000 911 calls for the month of June.

“That exceeds any month during the pandemic,” Fariss said.

More than 40% of those incoming calls, however, prove to be bogus and don’t merit a response. These are calls about a cough, a headache or other non-emergency best solved at home or at your local doctor’s office, officials said.

This comes at the detriment of callers trying to report serious crimes or victims of heart attack, stroke or other life-threatening conditions who are forced to wait before their query can get through.

It’s a frustration felt among the rank-and-file dispatchers who answer half a million calls each year — which averages to nearly one every minute every day. The frustration, officials said, lies in not knowing which will prove to save a life or hinder another.

Kern County Fire Department spokesman Andrew Freeborn and others believe the issue, at its core, is a cultural one, spurred by isolationism that worsened during the pandemic. COVID-19 also revealed a misunderstanding with what role first responders play in people’s everyday lives.

“We see a lot of people that are by themselves that don’t have that caretaker there,” Freeborn said. “And instead of calling that caretaker to say they don’t feel well, instead of bothering a friend or family member, they’ll just burden the 911 system for something that’s not a true emergency. Now, we just see a lot of people throwing up their hands and saying, ‘I don’t feel well, I guess I’ll just call 911.’”

Asked for an example, Freeborn recalled a 911 call they received from a woman who, upon running vitals, simply wanted a free ride to Santa Clarita.

“And I said, ‘but we’re in Bakersfield,’” Freeborn recalled. “And they said, ‘yeah, but I’m coming from Northern California, I’m trying to get down to San Diego… The system isn’t Uber.”

For non-emergencies, Kern Public Health Director Brynn Carrigan urged people to see their primary care doctor.

It’s also vital, she added, to prioritize preventive care such as annual exams and check-ups that, in tandem with a healthy diet and exercise, can reduce the reliance on first responders.

And the irony is that an ambulance ride rarely guarantees priority in hospital care. Unless someone is dying, many — more than a third in Kern County — who arrive by ambulance often have to wait with everyone else.

“We all know injuries and medical issues can be overwhelming and frightening,” Fariss said. “But we also want to ensure that we are responsibly using our 911 services.”

Quick thought on costs....

Using existing resources that must be on-duty anyway for fire responses to respond to an ADDITIONAL call is generally a bargain for the taxpayer. The marginal cost of sending that unit to a medical call vs. sitting around waiting for a fire call is the cost of a pint or 2 of fuel, maybe some medical supplies/equipment depreciation, and maybe some costs for premium pay for EMS certs.

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Colorado Springs Mayor exploring three paths for ambulance services after CSFD proposal was voted down

By Rebecca Gvozden

Jun. 24, 2024

https://www.kktv.com/2024/06/25/colorado-springs-mayor-exploring-three-paths-ambulance-services-after-csfd-proposal-was-voted-down/

COLORADO SPRINGS, Colo. (KKTV) - Colorado Springs, Mayor Mobolade, held another monthly briefing on Monday, to discuss public safety and highlight the 2024 Paris Summer Olympics.

One key topic brought to the table was the next steps in ambulance services. This comes after a proposal with Colorado Springs Fire Department (CSFD) to take over EMS services was voted down by city council earlier this month. Mobolade says he’s looking at three paths moving forward.

“One is to renegotiate and extend the AMR contract,” Mayor Mobolade said to the media. “Two is to open up a full request for proposal process, we call it also RFP. And then three, is to continue to work with my fellow council members to explore different alternative solutions, and those conversations are happening already.”

Mobolade says he’s in many conversations with the council members that voted ‘no’.

“A couple of them have said we still want to explore what it looks like for the fire department to take this on,” Mobolade said. “So that work is still ahead of us.”

Mobolade says he and city council members still have work to do with exploring their options but still believes this is the right time for the city to adapt to ever-changing public safety demands. What’s most important to him is delivering that promise of efficient public safety to the community.

“It’s trying to be smart, trying to create efficiencies, understand that every time that 911 call comes, and we have to deploy our firefighters we’re still the first on the scene and then an AMR any other private ambulances also shows up,” Mobolade said. “So, we’re paying twice for one service. That’s not, that’s not good stewardship.”

Other topics discussed pertained to violent crimes, motorcycle crashes, and staffing of the Colorado Springs Police Department (CSPD).

Mayor Mobolade says violent crimes have increased, and around this time last year there were about fourteen homicide investigations, however today, we’re at about twenty-one. He plans to have a meeting with the district attorney and his team, to try and understand the data around these increases.

With an increase in motorcycle crashes in the Springs, the mayor said he was told... with the city growing, they’re going to see a natural increase in this department of crashes.

Mayor Mobolade says CSPD is short about twenty people. They’re expecting to be fully staffed by early next year or in the middle.

Overall, he says public safety is at the forefront of his responsibilities.

“Public safety is at the top of my mind all the time, and in large part because it’s, no one else has that responsibility, but your government,” Mobolade said.

Special thanks to our colleague, Steve Wirth, for finding and sharing this Washington Post report!

Too many old people’: A rural Pa. town reckons with population loss

There is a deepening sense of fear as population loss accelerates in rural America. The decline of small-town life is expected to be a looming topic in the presidential election.

By Tim Craig

June 23, 2024 at 5:00 a.m. EDT

https://www.washingtonpost.com/nation/2024/06/23/rural-america-shrinking-population-pennsylvania/

SHEFFIELD, Pa. — Lee Goldthwaite might have the most stable job in this remote corner of northwestern Pennsylvania.

The caretaker of Sheffield Cemetery is busier than ever directing crews clearing trees to make space for more graves as deaths dramatically outpace births here and in other vast stretches of rural America.

Each time he buries a newly deceased resident he wonders how the town that once drew scores of young families will survive.

“We already lost our bank,” Goldthwaite said as he took a break from trimming the grass around headstones. “We lost our liquor store, and we may be about to lose our high school.”

Across rural Pennsylvania, there is a deepening sense of fear about the future as population loss accelerates. The sharp decline has put the state at the forefront of a national discussion on the viability of the small towns that have long been a pillar of American culture.

America’s rural population began contracting about a decade ago, according to statistics drawn from the U.S. Census Bureau.

A whopping 81 percent of rural counties had more deaths than births between 2019 and 2023, according to an analysis by a University of New Hampshire demographer. Experts who study the phenomena say the shrinking baby boomer population and younger residents having smaller families and moving elsewhere for jobs are fueling the trend.

According to a recent Agriculture Department estimate, the rural population did rebound by 0.25 percent from 2020 to 2022 as some families decamped from urban areas during the pandemic. But demographers say they are still evaluating whether that trend will continue, and if so, where.

Pennsylvania has been particularly afflicted. Job losses in the manufacturing and energy industries that began in the 1980s prompted many younger families to relocate to Sun Belt states. The relocations helped fuel population surges in places like Texas and Georgia. But here, two-thirds of the state’s 67 counties have experienced a drop in population in recent years.

The Center for Rural Pennsylvania, an agency overseen by the state legislature, estimates that Pennsylvania will lose another 6 percent of its rural population by 2050. Some counties, including Warren County, where Sheffield is located, will experience double-digit population declines.

State lawmakers and other leaders now consider the population loss a crisis and are drawing up plans to try to reverse the trend. They say neither Pennsylvania nor the nation can afford to lose small towns and the institutions that power them. Not only are they a touchstone of American life, but they are also key to driving certain sectors of the economy, like agriculture.

Already, the demographic shift is affecting where students attend school, how long residents have to wait for an ambulance and whether they can quickly see a doctor. In some cases, local governments themselves are on the verge of collapse as they struggle to fill open jobs and leadership positions.

The decline of small-town life is expected to be a looming topic in the presidential election as both President Biden and former president Donald Trump vie for votes in this critically important battleground state. Trump won many rural voters during his last two presidential campaigns with his populist economic message. Biden, meanwhile, is highlighting his administration’s investments in broadband and major public works projects.

“It’s kind of like building blocks. You pull one block and the wall gets weaker,” said state Rep. Eddie Day Pashinski (D), a lawmaker driving the conversation on solutions to population loss. “You pull another block out, and it collapses and that is kind of where our rural communities are.”

‘Too many old people’

Sheffield hugs the Allegheny National Forest and is about 75 miles southeast of Erie, the nearest big city. In the early 20th century, it was known for having the largest sawmill east of the Mississippi River. Back then, it was a hub for timber and oil exploration.

The town’s decline started decades ago as the lumber mills and tannery shops started closing. But it’s been only in the last decade or so that the full weight of the community’s future challenges began to be felt in intimate ways.

Sheffield’s only ambulance was taken out of service about two years ago, around the same time the community’s only day care closed due to low enrollment. Starting this school year, teens are being bused to a distant high school because there are not enough teachers to staff the local one.

Residents are peeved that the local bank branch and liquor store have closed. The organizers of the town’s beloved Johnny Appleseed Festival recently announced they don’t have enough volunteers or money to continue. And many of Sheffield’s churches no longer have full-time priests or pastors, deepening residents’ sense of malaise.

“I wish I had an idea to say, ‘If you do this,’ this place can be turned around,” said Jack Cashmere, 86, a lifelong Sheffield resident. “But I guess you just have too many old people like myself.”

In Warren County, nearly twice as many people died as were born in recent years, according to the Pennsylvania State Data Center at Pennsylvania State University. Sheffield Township, which includes a broader swath of land outside the town center, had one of the sharpest population declines in Warren County, according to census data. It is now home to 1,805 residents, a 23 percent decline compared with 20 years ago.

During its heyday, Sheffield was packed with commercial and recreational businesses that gave residents here just about everything they needed to maintain an active, middle-class lifestyle. There was a bowling alley, auto dealerships, doctors offices and pool halls.

High school football games as recently as the 1980s attracted 1,000 spectators, said Dennis Sturdevant, the self-described historian for the township.

Today, downtown Sheffield consists primarily of a small grocery store, a 150-year-old bar, one restaurant, two convenience stores, an antique shop and a small video-gambling room.

After most businesses closed or moved elsewhere, today one of the township’s biggest employers, Sheffield Container, employs just 25 people, said Lonny Connolly, the manager of the industrial packing company. The average salary is $18 an hour.

“I don’t know why the industry is not coming in,” Connolly said. “But I do know that is why people are moving out.”

A small class

The absence of children has Sheffield leaders on edge as they ponder how to keep the town afloat.

In 1980, Sheffield Area Middle-Senior High School had about 600 students. The current enrollment is just 224. The broader Warren County School District — encompassing most of the county — also saw its school enrollment decline by more than half since 1980.

Statewide, the Pennsylvania Department of Education estimates, there will be 60,000 fewer public school students by the 2027-2028 school year.

In a bid to account for the low enrollment and teacher shortages, the district decided to bus students in ninth through 12th grades to Warren, about a 30-minute drive away, each morning so they could learn core subjects such as a math and science. Students return to Sheffield High School in the afternoon for their electives.

But Warren County School District Superintendent Gary Weber said even more drastic steps may be needed, including possibly shuttering Sheffield’s high school altogether.

“There is no sign of growth in the future.” he said.

But to Sheffield residents, the idea that their community might soon be without a high school is alarming. If the school closes, they say, even more families could move out and the town’s problems will grow more entrenched.

Today there are 32 students in Sheffield Township’s graduating class.

Jamie O’Donnell, 33, has a second-grader enrolled in the Sheffield school system and another child entering kindergarten next year. She said having local schools gives Sheffield a “small-town atmosphere,” including the peace of mind that comes with having relatives who are also school bus drivers.

“We have to find a way to make it work,” said O’Donnell, who added that she may have to move her family if the high school closes.

“Once you close the school, your town dies,” Sturdevant, 80, said.

Ann Mitchell, the administrator at Sheffield’s Ruth M. Smith Center, said she doesn’t have much confidence that the numbers will rebound. In 2022, the center closed what Mitchell described as Sheffield Township’s only licensed day care as enrollment sank from an average of 40 children in the 1980s and 1990s to just eight children.

As she scanned an abandoned room where toy trucks, strollers and old blankets now collect dust, Mitchell said the closure is yet another sign that the once vibrant town is fading.

“I think [Sheffield] is slowly dying,” Mitchell said. “But I like to be positive and think there is still some hope.”

‘All gray hair’

Throughout Sheffield and the rest of rural Pennsylvania, the aging population has led to a crisis at one of the most fundamental small-town institutions: the local volunteer fire station.

The nation’s volunteer fire services rely on residents who leave work or home to respond to community emergencies. They have been a mainstay of life in small towns for centuries, putting out fires and transporting residents to the hospital, while also hosting bingo games, fish fries and potluck dinners.

But as the population ages and decreases, fewer people are signing up to serve as volunteers. Jerry Ozog, executive director of the Pennsylvania Fire & Emergency Services Institute, said the state had an estimated 300,000 volunteer firefighters during the 1970s. A state-commissioned study released in 2018 estimated Pennsylvania was down to 38,000 volunteer firefighters, and Ozog believes the number may have decreased further since then.

At many volunteer fire stations in Pennsylvania today, Ozog said, “it’s all gray hair and nobody under the age of 55.”

That has made it harder for fire stations to respond to emergency calls. Growing numbers of departments have also shelved their ambulance service, unable to find enough qualified volunteers who are willing to become a licensed EMT or paramedic. In some pockets of Pennsylvania, the nearest ambulance is now 40 minutes away, Ozog said.

Sheffield Township lost its ambulance in 2022.

Matthew Bell, the chief of the Sheffield Volunteer Fire Department and a township supervisor, said he made the decision to scrap the ambulance because not enough volunteers were responding to emergency calls. The township now contracts with a private ambulance service that must travel about 20 miles to get to Sheffield Township.

“We had four of us running all the ambulance calls and we said, ‘We can’t do this anymore’” Ball, 30, said.

Throughout Sheffield, there is deep concern about emergency response times. Doug Kennedy, associate director of the only funeral home in the township, said he has seen more people die in their homes since the local ambulance service ended.

But Bell said call logs show the wait time for a private ambulance is no longer now than when the township had its own service. And David Basnak, the president of EmergyCare, the private ambulance service that Sheffield contracts with, said it is more routine for paramedics to discontinue lifesaving efforts for heart attack patients at home. That’s because EMTs have more advanced resuscitation equipment on hand than they used to.

“Everything they can do in a hospital for patients, we can do in the house,” he said.

Lonely bar patrons

As the population ages and declines, Sheffield Township has struggled to operate its government and maintain activities that the community can be proud of.

For 17 years, residents looked forward to the annual three-day Johnny Appleseed Festival, when thousands of visitors would cram into town to watch professional lumberjack, horse, tractor, cornhole and pie-baking competitions.

But this spring, event organizers announced they could no longer staff the festival. As residents age, it has become harder to find the youthful volunteers needed to put on such a labor-intensive festival, said Sandy Setili, an event organizer.

“You can’t sustain a festival as big and physically demanding as ours if you don’t have volunteers,” Setili said.

Sheffield suffered another blow this year when several high-ranking township employees quit — including two of three supervisors. The township appointed one person but couldn’t find anyone to fill the second vacancy. It then took the unusual step of putting an ad in the local paper to find someone to keep the local government running.

As the presidential election approaches, many residents in this deeply Republican town say they view Trump as having a better vision for salvaging rural America, even though Biden has steered billions of dollars to initiatives that support rural America.

But at the Lee House, one of two remaining bars in Sheffield Township, many patrons were not optimistic that either Trump or Biden have the answers needed to save the community. The bar, which dates back 150 years and advertises on its front door that smoking is still allowed indoors, now routinely closes at 9 p.m. due to “fewer and fewer people,” said Carla Allen, the bar’s owner.

“I don’t want either of them for president,” said Barb Strike, 54, as she puffed on a Parliament cigarette and sipped a Bud Light. “They don’t care about us because no one in this town is rich enough for them to care.”

‘We are going to stick around’

Jim Decker, chairman of the Warren County Chamber of Business and Industry, said local leaders must figure out a way to reinvent the community. The Center for Rural Pennsylvania report said the county would lose 11 percent of its population, including 26 percent of its working-age adult population, by 2050.

Although Warren County lacks easy access to an interstate highway, Decker said the county will try to market its location near state forests and recreational areas such as the Allegheny River to draw in new residents. He even wonders whether climate change could one day force more people to seek out cooler climates such as northwestern Pennsylvania.

But Decker acknowledged the planning for Warren County’s recovery is “a daunting task.”

Kenneth M. Johnson, the demographer at the University of New Hampshire, said the deck remains stacked against most rural communities, except for those within proximity to larger metropolitan regions or those with industries that rely heavily on immigrant labor.

“Barring some outside occurrence, it’s very unusual for counties to recover,” Johnson said.

Dirt from the most recent burial in St. Michael’s Byzantine Catholic Cemetery in Sheffield sits piled up near the top of a hillside. (Justin Merriman for The Washington Post)

Goldthwaite, the caretaker of the Sheffield Township cemetery, isn’t yet ready to believe his community will wither.

Even as he laments the loss of 13 people from his church over the past three years, Goldthwaite believes younger families will eventually come. There must be other people, he says, who want to be able to look out their door and see black bears, turkeys and deer, or fish trout out of the Tionesta Creek.

“I don’t care what anyone says about it. I think it’s a great little community,” said Goldthwaite, speaking over the sound of the chain saws clearing more space in the cemetery. “I think we are going to stick around.”

Small Connecticut towns struggle to keep up with emergency calls as staffs dwindle

By Susan Danseyar,

Staff Writer

June 23, 2024

https://www.ctinsider.com/journalinquirer/article/ct-ems-calls-volunteer-emts-response-times-19487921.php

First responder Ryan Litwin says he chose to live in Litchfield because of its fire department, and wonders how many people would pick a community to live in because of its access to emergency services.

"I love the department and grew up with it, volunteering with it for years," said Litwin, who serves as the chief of the Bantam Fire Company, which provides services to the town along with the Litchfield Volunteer Ambulance. "That's actually one of the major reasons why I decided to buy a house here."

Everyone he knows says they appreciate volunteer firefighters and emergency medical technicians, Litwin said, "but do we really understand their challenges and sacrifices?"

Litwin said he's concerned about the number of volunteer first responders — who have to leave families and jobs "at the drop of a hat" — possibly dwindling in Litchfield some day. It's an issue that could very well have an affect on service and response times.

He joins a number of emergency medical service providers in small, rural Connecticut communities who say it's a challenge to keep up with increased call volumes while seeing decreases in available staff.

On the opposite side of the state, towns in the northeastern quadrant are definitely "feeling the pinch" of attracting and maintaining personnel for emergency services, said Tyler Millix, executive director of Tolland County Mutual Aid Fire Service Inc., which provides 911 services to 17 towns encompassing 34 emergency service organizations within Tolland, Windham, and Hartford counties.

More calls, fewer staff

Data supports Millix's claim in regards to a number of Connecticut agencies. According to the state's Office of Emergency Medical Services, EMS providers throughout the state responded to anywhere from 55,000 emergencies in April 2020 to 83,000 in December 2022. Of the 396 EMS providers in the state, over 40 of them saw their number of active crew members drop.

Stratford lost 83 active crew members over a two-year period, dropping to 94 by 2022. The Suffield Volunteer Ambulance Association lost 42 active crew members, with EMS personnel dwindling to 77 in 2022. And Enfield Community Ambulance lost 16 active crew members, going down to 46 by 2022.

OEMS's 2023 report is awaiting final approval and will be ready within a month or so, according to data manager and epidemiologist Eliza Little, but the 2022 data is the most recently available now.

"Every town is facing increased call volumes and decreased manpower, whether that's volunteer or paid people," Millix said. "It's becoming harder and harder to find people to become contributing members of the organization."

Former Somers Fire Chief John Roache, who is now heading Mansfield's department, told officials in March his department once had a roster of volunteers who would stay for years, but turnover has become faster while call volume for advanced life support keeps going up — both in town and the several area communities where his personnel provide advanced life support. The Board of Selectmen allocated $20,000 in the 2024-25 budget for a campaign to retain and recruit volunteer firefighters. 

Interim Somers Chief Keith Allard, who took over for Roache in May, has been a volunteer firefighter with the department for over 40 years. He said EMS calls are the most frequent for the department, with between 1,000 and 2,000 each year. The number his staff respond to in town and for other communities has increased substantially in the last 10 years, Allard said.

Stafford officials formed an Emergency Services Commission for directors of the town's two fire departments and ambulance company to discuss the best ways in the future to handle the growing demand for all calls, including EMS.

West Stafford Fire Chief Joe Lorenzetti said there's definitely been an increase in calls for EMS and fire/rescue incidents. About 10 years ago, he said the departments received 900 to 1,000 calls a year. In 2022, that number increased to 1,024, and to 1,400 in 2023. For 2024, Lorenzetti said he's anticipating the call volume will be between 1,600 and 1,700 calls.

Alex Moore, director of the Stafford Ambulance Association, said his personnel are currently answering about 1,750 calls, averaging about four or five a day, that include advanced life support and mutual aid. To meet needs, he said the goal is to have two people on duty at all times. However, Moore said, it's a struggle to find qualified EMTs and retain them.

The hourly wage for EMTs is $17.50 an hour, said First Selectman William “Bill” Morrison, who is also assistant chief of the West Stafford Fire Department. He pointed out less dangerous jobs such as working in the food industry pay that same wage. EMTs must also undergo extensive training that's not only time-consuming but also expensive, he said.

Litchfield EMS calls are covered by the all-volunteer Bantam Fire Company and Litchfield Volunteer Ambulance, which is staffed by a combination of volunteers and staffing service employees.

Litwin said both services have seen a dramatic increase in EMS call volume over the years, attributing it to aging baby boomers and an increase in housing for older residents in the area.

"Those are what I would call a target hazard," he said. "They significantly increased the call volume because of being a health care facility or having agin

The Bantam Fire Company has 70 firefighters, and 30 EMTs with some personnel serving as both. It's a close "brotherhood" with volunteers as the agency's backbone, Litwin said.  However, he said every single agency in the country is not where it wants to be in terms of recruiting and retaining personnel.

"Even if you have enough, you always want more," Litwin said. 

Bantam has a very strong membership, Litwin says, but in the summer, many people are often away on vacation. "It doesn't take very much to upset the balance." 

Litwin said the two agencies are keeping up with demand and actively trying to recruit people. "But we are concerned," he said. "We have some young people and older people who are the most reliable but they're aging out." 

He said it's not true that people don't want to volunteer anymore. "Litchfield is busier than many agencies and just needs more volunteers."

Response times

Another challenge for EMS providers is that the very nature of such calls demands immediate attention or, at the very least, as quick a response as possible. 

According to OEMS data from 2020-22, urban towns had the most calls at 483,913, with the shortest average response time of 7.39 minutes. Suburban towns had 95,789 calls with an average response time of 8.12 minutes. Rural towns had the fewest calls at 89,895 yet the longest average response time of 10.7 minutes.

About nine minutes was the average response time across Connecticut for EMS calls in 2022, according to OEMS data. Response time is calculated from the moment dispatch notifies an agency of an emergency to the moment a crew arrives on the scene.

New London, at 5.01 minutes, had the fastest average response time in the state, according to OEMS' most recent data. Washington, at 18.82 minutes, had the slowest average.

OEMS data for average response times takes into account outliers such as weather and transport delay because of traffic.

OEMS reported Somers, with one fire station, had an average response time of 6.02 minutes for EMS calls in 2022.

Allard recently compiled data for the past six months. There were 488 calls in Somers with a response time of 5.50 minutes. The 202 mutual aid calls to Stafford during the same time period had a response time of 11.13 minutes; for the 16 calls to Enfield, response time was 9.25 minutes; and for the 63 calls to Ellington, response time was 9.55 minutes, he said. The department made 5 calls to East Longmeadow, Massachusetts, with a response time of 10.57 minutes.

Stafford, with two fire stations, had an average response time of 10.70 minutes for EMS calls in 2022, according to OEMS data. Moore said calls in town are currently averaging about nine to 12 minutes.

One of the particular challenges for Stafford's response times to calls lies in its geography. Stafford is the third-largest town in the state by acreage, Morrison said.

"We have 54 square miles," he said. "Certainly, the distance around town makes a difference because we can get out the door fast but have a longer ride than many towns to our destinations." 

The town of Litchfield, with five fire stations, is also quite large in terms of land, with 56 square miles, Litwin said. 

The average response time for EMS calls in Litchfield in 2022 was 8.08 minutes.

"Regardless of fire or rescue, fast response times are always what we want but is that realistic?" Litwin said. "I can have staff and the ambulance in my fire station but the furthest point of my district is still over 12 minutes away and that's just driving time in good weather."

Interesting perspective... Community and EMS system leaders should carefully evaluate current evidence-base practices and re-design EMS systems for success and sustainability.

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Multnomah County (OR) Ambulance Crisis: By Design or Mistake?

Multnomah county has turned a contracting failure with AMR into an ambulance crisis, writes Stephen Dean, PhD.

Stephen Dean, PhD

06.19.2024

https://www.jems.com/commentary/multnomah-county-or-ambulance-crisis-by-design-or-mistake/

The Failsafe Franchise

EMS pioneer Jack Stout created the Failsafe Franchise in the 1980s when he was hired to fix the ambulance service in Fort Worth, Texas. He designed the model to produce clinical quality and economic efficiency through contract provisions that use competition in the wholesale market to ensure the lowest cost; and then make available an ingenious set of provisions to hold the winning ambulance bidder accountable for the promised performance.⁵

The Accountability provisions are designed to ensure that should an ambulance provider be unable to perform, it can be replaced overnight without any degradation in service to the patients. The Failsafe Franchise ensures accountability through two key contract provisions: first, the 3 Way Lease, and second, the process to determine if an ambulance provider has failed to meet its contractual obligations.⁵

The 3 Way Lease

Jack Stout was the first person to use the 3 Way Lease in EMS contracting. It simply requires a contractor to lease all its ambulances and equipment in a manner that allows the contracting entity to acquire all this equipment by assuming the lease payments if the contractor is terminated. This arrangement prevents unscrupulous ambulance companies from holding patients hostage by threatening to abscond with the system’s infrastructure if the company is replaced.⁵

Contractor Due Process

The second innovation protects the ambulance provider along with ensuring accountability, by providing due process in the form of required notifications of violations of contract provisions as well as opportunities to provide correction plans to fix violations. The replacement of an ambulance provider through the declaration of “material breach” is the county’s ultimate tool to ensure accountability.

Jack Stout advocated for the use of private ambulance companies because, unlike fire departments or publicly operated ambulance services, they could be replaced. He famously, or infamously, said the biggest advantage of using a private company is that they are easy to fire if they do not perform. 

Failed Bid Process

In 2018, the Multnomah County (OR) Health Department conducted a competitive bid using a Failsafe Franchise system design. AMR was the incumbent provider with a history of more than 20 years providing eight-minute response times with 90% reliability to life threatening emergencies with Advanced Life Support (ALS) ambulances staffed with two paramedics each, as required by their contract with the county.⁴

In addition to those requirements, the request for proposal (RFP) contained over a hundred other requirements and deliverables including live monitoring of the system and reporting of response time and clinical performance.⁶ With no indications that the county was in the least dissatisfied with the incumbent provider and such a daunting list of clinical demands, there was only one bid submitted, that of the incumbent.⁷

When AMR and the county completed their negotiations to set the rates patients would be charged by AMR, the rates were the highest in the county’s history. The county agreed to an immediate 34% increase in rates and annual rate increases based on the CPI of up to 5.5% per year. These annual rate increases were automatic and not dependent upon AMR even meeting the minimum standards in the contract.⁷

By attracting only one bidder, the county effectively negated the provisions for obtaining a competitive rate.

Including the initial 34% rate increase, ambulance rates have increased by 70% since the county entered its contract with AMR in 2018. For the past two years patients have seen rates go up even though the county and AMR both agree that the service patients are currently receiving is substandard.⁸

This bid failure should have been a warning to the county that should AMR fail to perform, it might be difficult to find another provider that could meet the county’s stringent standards, particularly its unusual minimum staffing requirement of two paramedics per ambulance rather than one paramedic and one EMT.

Contract Renewal Failure

While AMR remained in compliance with response time standards in late 2021, it had become evident that increasingly longer response times were occurring because of a staffing shortage that was getting worse each month. The county had an opportunity to address this issue, and rate issues, with AMR prior to the expiration of the AMR contract in August of 2023.⁶

Though the original contract had a five-year term, it allowed the county to make an offer of renewal at the county’s sole discretion. That renewal offer however had to be presented to AMR at least 18 months prior to end of the initial five-year term, making it due before March 1, 2022.

The county made the offer to renew 17 days late. The County Board of Commissioners (Board) held no hearing, received no briefing, and voted to approve the renewal on its consent agenda, where multiple routine or inconsequential items may be approved with one vote.⁹

The county’s EMS Office Staff submitted a misleading “Agenda Placement Request”¹⁰ which stated in part, “Contractually, if AMR performance measures are met, an extension of an additional five years shall be issued.”

According to the contract, however the request should have stated, “Contractually, if AMR performance measures are met, an extension of up to an additional five years shall may be issued.”⁶

Why the staff did not just copy the exact contract language is not officially known.

Commissioner Sharon Meieran, MD, JD, who has been an outspoken advocate for patient care and at odds with both the EMS Office and County Chair for their inept handling of the staffing crisis told the press, “The fact that renewal of the ambulance contract was done as a ‘consent agenda’ item is so bizarre as to suggest a conscious intent to hide this from the board. And it succeeded.”⁹

To date the EMS staff have not commented on the contract renewal or the misrepresentations during the process.

The renewal process was the county’s last opportunity to negotiate on equal terms with AMR about staffing and rate concerns that were, or should have been, evident from the increasingly longer response times each month due to the national paramedic shortage.

Instead, the Board approved the contract renewal on March 17 and just two weeks later, AMR was out of compliance with the contract’s response time standards, and has been ever since.¹¹ The county threw away the opportunity to address staffing and rates in a renewal negotiation.

Failure to Fine and Failure to Replace the Contractor for Material Breach

The Failsafe Franchise contains two types of penalty provisions: fines for long response times; and replacement of an ambulance provider for major failures to meet contract standards, including repetitive failures to meet monthly response time standards.⁶

The fundamental problem causing the substandard response times is a lack of staffing for AMR ambulances. And the reason AMR lacks staffing is because it cannot retain, nor recruit, enough paramedics due to the ongoing national shortage of paramedics which started after the pandemic.⁸

Changing the staffing requirement temporarily to a minimum of one medic and one EMT would allow AMR to keep all its units staffed until the paramedic shortage ends because there is no shortage of EMTs. Every other county in Oregon allows ALS ambulances to be staffed in this manner as do all the surrounding counties in the state of Washington.¹²

The county has expressed concern that two paramedics are needed on cardiac arrests and that area first responders are not always able to send a paramedic to these calls. Requiring AMR to send two ambulances to cardiac arrest calls, however, would be simple enough with a fully staffed system.

There are approximately seven hundred cardiac arrests a year out of 120,000 responses. It also turns out that in 2022 fire paramedics were present at 99.9% of the cardiac arrests in the city of Portland where most of the county’s arrests occur. The sole exception was a witnessed arrest in an ambulance in route to the hospital. So, the actual number of two ambulance responses required would be much less than seven hundred.¹³

The county’s medical treatment protocols require rapid transport to the hospital of patients suffering from strokes, heart attacks, trauma, and childbirth complications for optimal care. The county monitors the length of time ambulances are on scene at these types of calls to ensure that patients arrive as soon as possible at the hospital to receive time critical care or surgical interventions. Long response times contribute directly to delays in getting these patients the care they require.¹⁴

Failure to Fine for “Outlier” Response Time Violations

The county had earlier started chipping away at the Accountability provisions of the system design by not fining AMR for dangerously long response times, referred to as “outlier” responses, starting in the first year of the Contract. The Contract defines these long response times for Code 3 (life threatening emergency) calls as 13 minutes or greater in urban areas and 25 minutes or greater in rural areas.⁶

The purpose of the outlier fines is to discourage AMR from providing extremely long response times to a few unlucky patients to maintain overall compliance.

AMR and the county cited the paramedic shortage in 2021 and 2022 as a reason for outlier response times. But by forgiving the fines for these long responses, the county created an incentive for AMR to scrape by on compliance at the expense of these few patients who received the very long response times.¹⁵

Failure to Declare Material Breach

According to the accountability provisions of the Failsafe Franchise, if an ambulance provider fails to perform, the contracting jurisdiction can replace the provider after notifying the provider of its failure to perform and offering the provider the opportunity to correct the failure.⁵

Repetitive noncompliance occurs if AMR fails to meet response time compliance three months in a row. If the company fails to correct the compliance the county can declare AMR in Material Breach and initiate the replacement of AMR with another provider. However, the county has “sole discretion” to determine “Material Breach,” so the county has leeway about whether, and when, to invoke these provisions.⁶

The county issued a notice of repetitive noncompliance in August 2023 after 18 months of noncompliance and after AMR’s corrective plan to improve paramedic recruiting and use basic life support (BLS) Ambulances to improve response time performance failed. The county notified AMR it would begin fining the company, as well.¹⁵

In November 2023, the county fined AMR over $500,000 for long response times that occurred in a single month, August 2023. The county’s Health Director also announced that the county was not interested in replacing AMR.¹⁶ AMR promptly appealed the fines to that same Health Director as specified in the Contract. He denied the appeal, but AMR has still never paid any fines.¹⁷

The county has not presented medical research or evidence that shows a benefit to patients of two paramedics over one paramedic absent rapid response times. In fact, the research presented by the county and AMR show the opposite, that response times are much more significant than the presence of a second paramedic.¹⁸

Failsafe Franchise or County to Blame?

The county had effectively abandoned the Failsafe Franchise system design by the end of 2023, including its provisions for guaranteeing low rates through bid competition and quality through its system of fines and provisions for contractor replacement.

In every instance, it was the county that circumvented or just ignored the safeguards in the model; the same safeguards which were incorporated into its RFP and contract with AMR, to guarantee performance accountability and fair, competitive rates.

After the summer of 2022, rates continued to increase annually even as AMR’s compliance with the standards upon which those rates were based continued to plummet. As personnel costs decreased by millions of dollars per year due to the staff shortage, there was an opportunity instead for AMR to reap enormous windfall profits.

The Board of Commissioners voted in February 2024 not to take immediate action to address the long response times and poor EMS quality that exists today but did approve a plan to study the problem over the next year.¹⁹ That plan also includes mediation with AMR apparently to prevent the implementation of the one medic, one EMT staffing solution proposed earlier by AMR which was endorsed by every EMS first responder organization and every city in the county.

County Commissioner Sharon Meieran expressed her frustration with the board’s inaction in December 2023.

I would just conclude then that the herculean effort to avoid talking about ambulance response and emergencies is mind-blowing to me, and I just watch it happening. And as a board, I think our responsibility is to hold the chair to account in terms of bringing things to the attention of the people for board meetings and allowing us to discuss what is literally costing lives of Multnomah county residents every day that you fail to act.²⁰

The cause of the Failsafe Franchise model’s failure in Multnomah County is the Board’s forfeiture of its ability to hold AMR accountable. This is because the EMS medical director has refused to adapt the staffing standard to the reality of the national paramedic shortage in Oregon. AMR cannot be replaced, because no other ambulance provider in the country can simultaneously meet the county’s response time requirements while also meeting the county’s stringent two-paramedic staffing requirement.

To date, based upon the recommendation of the county’s EMS medical director, the county chair and two lame duck commissioners whose terms will end in December have blocked all attempts to change the staffing standard to address the ambulance shortage, the latest vote taking place on June 6, 2024. This vote affirms the continuation of the county policy of harming patients and enriching AMR.^{19, 21}

Were just one of these four persons to change their position, the ambulance shortage could end, and contractor accountability be restored.

Editor’s Note: This commentary reflects the opinion of the author and does not necessarily reflect the opinions of JEMS. 

References

1. Watson, E., A Portland Man Died Waiting for an Ambulance that Didn’t Arrive for 32 Minutes:. 2023, KGW-TV: Portland, Oregon

2. Pederson, J.V., Chair Jessica Vega Pederson Announces Four-Point Plan to Address Ambulance Service Crisis. 2024: Portland, OR

3. Haas, R., AMR Pressures Multnomah County Over Ambulance Staffing Rules. 2024: Portland, OR

4. Lewis, M., Paul; Deputy Health Officer, Multnomah County, D.E.A. Knott, Multnomah County, and M. Oxman, Gary; Health Officer, Retired, Multnomah County. Multnomah County Emergency Medical Services Planning and Procurement Project Kickoff. [Web] 2017 2024/01/01 [cited 2024 January 11, 2024]; Available from: https://multco-web7-psh-files-usw2.s3-us-west-2.amazonaws.com/s3fs-public/EMS_project_kickoff_slides.pdf.

5. Stout, J., The Failsafe Franchise. Journal of Emergency Medical Services, 1985. 10(10): p. 56-58.

6. Multnomah County, O., Multnomah County Services Contract Agreement for Exclusive Ambulance Service Contract # 5600002522. 2018: Portland Oregon. p. 56

7. Multnomah County, O., Board Approves New Five-Year Contract for Ambulance Services. 2018, Multnomah County, Oregon: Portland, Oregon

8. Lewis, M., Paul, R. Lauer, and D. Schappe, Perspectives On Addressing Multnomah County Ambulance Delays Amid Staffing Woes. 2023, Oregon Public Broadcasting

9. Haas, E., ‘Consent Agenda’ Was Key to ‘Hide’ MultCo-AMR Contract Renewal. 2024: Portland, OR

10. Monnig, A., Multnomah County Agenda Placement Request. 2022: Portland, OR

11. Lewis, P. and A. Monnig, EMS Ambulance Services Briefing – September 19, 2023. 2023: Portland, Oregon

12. Legislature, O.S., Oregon Revised Statutes:  Chapter 682 — Regulation of Ambulance Services and Emergency Medical Services Providers. 2023: Salem, OR. p. 29

13. Haas, E., Paramedic Paradox: Unraveling Multnomah County’s Response Time Dilemma. 2023: Portland, Oregon

14. Jui, M., Jonathan; EMS Medical Director, Multnomah County, Patient Treatment Protocols  Section 10:  Treatment. 2024.

15. Pederson, J.V., Chair Jessica Vega Pederson: County Will Issue Penalties to Address AMR Performance Issues. 2023: Portland, Oregon

16. Pederson, J.V., Multnomah County fines AMR $513,650. 2023, Multnomah County Executive: Portland, OR

17. Del Savio, A., Tensions and Wait Times Rise During Multnomah County Ambulance Shortage. 2024, Pamplin Mediaw

18. Watson, E., Why Ambulance Provider AMR Says Multnomah County’s Emergency Medical System Is in a State of Crisis. 2023, KGW-TV: Portland, Oregon

19. Haas, E., ‘Sinking Ship’: MultCo Board Votes Down Immediate Action, but Passes Long-term Approach to Ambulance Crisis. 2024: Portland,OR

20. Haas, E. and A. Plante, Multnomah County Commissioners Meieran, Vega Pederson Clash Over Ambulance Staffing Crisis. 2024: Portland, OR

21. Nelson, T., Deputy Board Clerk, Board of County Commissioners, Multnomah County, Oregon, Minutes of the Multnomah County Board of Commissioners, Thursday, June 6, 2024,. 2024: Portland, OR

Interesting approach!

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Montana Creates Emergency ‘Drive-Thru’ Blood Pickup Service for Rural Ambulances

By Arielle Zionts

JUNE 17, 2024

https://kffhealthnews.org/news/article/montana-emergency-drive-thru-blood-pickup-rural-ambulances/

Crystal Hiwalker wonders if her heart and lungs would have kept working if the ambulance crew had been able to give her a transfusion as the blood drained from her body during a stormy, 100-mile ride.

Because of the 2019 snowstorm, it took 2.5 hours to drive from her small town of Lame Deer, Montana, to the advanced trauma center in Billings.

Doctors at the Billings Clinic hospital revived Hiwalker and stopped the bleeding from her ruptured ectopic pregnancy. They were shocked that she not only survived after her heart stopped beating and she lost nearly all her blood, but that she recovered without brain damage.

The Montana State Trauma Care Committee, which works to reduce trauma incidents and to improve care, later realized the ambulance that carried Hiwalker had passed near two hospitals that stocked blood. What if Hiwalker had access to that blood on her way to Billings, committee members asked.

That realization, and question, inspired committee members to create the Montana Interfacility Blood Network, which they say is the first program of its kind in the U.S. The network allows ambulance crews to pick up blood from hospitals and transfuse it to patients on the way to the advanced care they need.

“We kind of came up with the idea of having a blood handoff — like driving through a fast-food restaurant drive-thru — and picking up blood on the way,” said Gordon Riha, a trauma surgeon at the Billings Clinic trauma center, where Hiwalker was treated. Riha said timely blood transfusions can prevent death or permanent brain injury.

The network is aimed at rural patients, who face elevated rates of traumatic injuries and death, said Alyssa Johnson, trauma system manager for the state of Montana.

“We have to get more creative. We don’t have a blood bank on every corner, and we don’t have a Level 1 trauma center on every corner,” Johnson said.

Network leaders say the program has helped at least three patients since it launched in 2022. They hope it will be used more in the future.

Hiwalker is excited about the program.

“I’m so glad that something like this got started, because it would save a lot of lives from where I live,” she said.

Hiwalker said she has heard about people bleeding to death after car crashes, gunshot wounds, and stabbings in her rural community. Johnson said work injuries, cancer, gastrointestinal problems, and childbirth can also cause serious bleeding.

The Montana trauma committee began discussing the blood network a few months after Hiwalker’s brush with death. First, it created a map of 48 facilities with blood banks. Then, it created guidelines for how hospitals, blood banks, ambulances, and labs must communicate about, package, transport, document, and bill for the blood.

The network is used only during emergencies, which means there’s no time to test patients’ blood types. So it uses only type O red blood cells, which can be transfused safely into most patients.

The receiving hospital — not the one that provided the blood — is responsible for billing patients’ insurance for the blood. The cost depends on how much blood patients need but typically ranges from several hundred dollars to more than a thousand, said Sadie Arnold, who manages the blood bank at Billings Clinic.

Arnold said blood must be stored in a lab and managed by professionals with specific degrees, clinical experience, and board certifications.

Some rural hospitals lack space for a lab or money to recruit these specialists, Arnold said. Or they may not need blood often enough to justify storing a product that can expire and — especially during the current national blood shortage — is needed elsewhere. The network uses blood that has a maximum shelf life of 42 days.

Rural hospitals that do store blood may have only small amounts on hand. A rural Montanan with severe bleeding experienced that firsthand when he went to the nearest hospital, which had only one unit of type O blood, according to a report on the blood network. But thanks to the new program, ambulance medics picked up more blood from a hospital halfway through an 80-mile drive to the trauma hospital.

Ideally, rural patients with serious bleeding would be transported by medical helicopters or airplanes outfitted for transfusions. But, as in Hiwalker’s case, flying can be impossible during bad weather. That can mean hours-long ambulance rides. Some towns in northeastern Montana, for example, are more than 250 miles away from the nearest advanced trauma center.

“This was truly designed for kind of that last-ditch effort,” Johnson said. When “we’re out of options, we’ve got to get the patient moving towards a larger center, and we can’t fly.”

The blood handoff may involve the ambulance stopping at the second hospital, Johnson said. But during one incident, a police officer picked up the blood and delivered it to the ambulance at a highway exit, she said.

Ambulances may also pick up a paramedic or nurse to provide the transfusion along the way, since many rural ambulance crews are staffed by emergency medical technicians, who in Montana aren’t authorized to do so.

Medics in other cities and states, including ones with rural areas, have started performing blood transfusions in ambulances and helicopters, said Claudia Cohn, chief medical officer of the national Association for the Advancement of Blood & Biotherapies.

She said researchers are also interested in the potential of using frozen and freeze-dried blood products, which could be helpful in rural areas since they’re easier to store and have longer shelf lives.

Johnson said the Montana Interfacility Blood Network is the only program she knows of specifically aimed at rural patients and involving ambulances picking up blood from hospitals along their routes. She said the network is gaining interest from other states with large rural regions, including Oregon.

Hiwalker said receiving a blood transfusion in the ambulance could have prevented her near-death experience and the trauma her husband faced from seeing her suffer as he rode in the ambulance with her. She’s glad her ordeal led to an innovation that is helping others.

Protest erupts over ambulance contract for Kauai and Maui counties

by: Lucy Lopez

May 31, 2024

https://www.khon2.com/local-news/protest-erupts-over-ambulance-contract-for-kauai-and-maui-counties/

HONOLULU (KHON2) — A week following the Department of Health’s decision to award the ambulance contract for Kauai and Maui Counties to American Medical Response (AMR) after a competitive bid process, a protest has emerged.

Falck USA, the unsuccessful bidder, filed a formal notice of protest Friday, citing alleged errors in the calculation of their scores and inconsistencies in the evaluation criteria utilized for the contract awards.

STATEMENT FROM TROY HAGEN, CHIEF COMMERCIAL OFFICER FOR FALCK USA

“We filed a notice of protest after identifying what appears to be a clear error in calculating Falck’s scores, along with inconsistencies in the evaluation criteria used to award the contracts. We look forward to opening discussions with the Department of Health and ensuring these vitally important emergency medical services contracts are awarded based on a fair and transparent process.

Falck continues to stand ready to serve. As a foundation-owned healthcare provider, we would bring a fresh perspective, unmatched financial stability, reliable services developed around global best practices, and a deep commitment to delivering the highest quality care to the communities we serve.”

This marks the second time that the ambulance bid process has faced protest.

In August of last year, Falck was initially awarded the contract, but AMR filed a protest, prompting the Department of Health to restart the bidding process.

In response to the latest protest, the Department of Health stated that it cannot proceed with the contract award until the protest is resolved and declared that it will refrain from further comments on the matter at the time.

The protest introduces a new twist in the ongoing saga surrounding emergency medical services in Kauai and Maui Counties, leaving stakeholders and residents awaiting a resolution to ensure timely and effective ambulance services in the region.

The work begins for county run EMS

Emergency Medical Services in Henry County could transition from Henry County Health Center to the county itself

AnnaMarie Ward

Jun. 5, 2024

https://www.southeastiowaunion.com/se-iowa-union-mount-pleasant/the-work-begins-for-county-run-ems/

MT. PLEASANT — Henry County Supervisors approved and adopted the third and final reading of a resolution which declares emergency medical services as an essential county service in Henry County.

If all goes well and voters approve the tax levy this November, Emergency Medical Services will become a Henry County entity.

“The Board hereby declares EMS to be a central county service in the county and hereby directs that any and all other actions be taken as necessary to proceed with the process under Iowa Code 422D.1 to declare EMS an essential county service,” Supervisor Greg Moeller read from the resolution at Thursday, May 30 Board of Supervisors meeting.

“Now the work begins,” Henry County Health Center Chief Financial Officer David Muhs said following the board’s approval.

According to the resolution, these “other actions” and additional work will include creating a County EMS System Advisory Council, “to assist in researching and assessing the service needs of the county and guiding implementation with respect to the potential imposition of a local options income surtax and/or ad valorem property tax for EMS in the county.”

While declaring EMS an essential county service means the county will foot the bill, it does not mean the entire cost will be passed onto taxpayers.

According to Muhs, the approximate cost of operating the EMS service currently is $2.4 million and the service is receiving about $2.2 million in revenue. Muhs states this revenue has been consistent percentagewise over the last five to 10 years.

Discussions with the Board of Supervisors revealed a cap on tax levy ability for EMS will be 75 cents per $1,000 valuation.

According to Moeller, it will be the responsibility of the County EMS System Advisory Council to “Bring it to the public to let them know that the 27 cents that the hospital now levies for ambulance services will be included in this 75-cent levy.”

Included in this 75 cents however, will be the 27 cents per $1,000 valuation already implemented in the Henry County Health Center’s general basic levy. These 27 cents will be rolled into the total 75 cents and taken out of the hospital’s levy.

Wayne County Commission seeks temporary EMS solution until levy takes effect

by: Jessica Patterson

Posted: Jun 10, 2024

https://www.wowktv.com/news/west-virginia/wayne-county-wv/wayne-county-commission-seeks-temporary-ems-solution-until-levy-takes-effect/

WAYNE COUNTY, WV (WOWK) – The Wayne County Commission says a newly passed levy will help emergency response in the county, but they’re working on a plan to help until that levy takes effect next year.

The Wayne County Public Service Levy, designed to help improve emergency services, passed in the Primary Election in May by just one vote. Initially, it appeared the levy would fail, with just 59.9% of the needed 60% vote. However, once all mail-in ballots were accounted for and after canvassing, the levy pulled through by one vote.

The Wayne County Commission took to social media this Sunday to thank those who voted in support of the levy.

“No matter how you voted, your political affiliation or your community, the passage of this levy will benefit each person in the county at a very reasonable cost,” said the Wayne County Commission. “According to the commission, the average property owner will pay less than $100 per year for this improved service.”

‘It’s a problem we inherited’: Wayne County Commission talks solutions to EMS issues

They say one goal of the levy is to create a 24/7 county-run EMS system to alleviate the county’s slow ambulance response times. Residents in the area have told 13 News the problem with response times gives them a helpless feeling after multiple instances where families have called 911 only to be told an ambulance isn’t readily available.

Commissioners say the levy will begin providing funding for EMS and other services in July 2025. The commission also says they are working to implement a temporary strategy to improve emergency response times until the levy takes effect.